Is “out-of-network” a dirty phrase?

Is “out-of-network” a dirty phrase?

DR. MICHELLE MILLNER, PT, DPT, OCS

With all the changes to health care in the past few years, it’s easy to get confused. There are in-network benefits, out-of- network benefits, co-payments, co-insurance, deductibles, and a host of other regulations that determine what care is covered, not covered and how much you will or will not pay for medical and health related services.

The definitions of all of the above terms is beyond the scope of this blog post, however, it’s important to understand that “out-of-network” is not necessarily a bad thing.

The term “out-of-network”, in particular, has become a “dirty” phrase.

Essentially the phrase means the the provider does not have a standing agreement with your insurance company. This might sound like a bad thing because the provider can set his own rates. However, it also means that the provider is not limited to preset treatment options or pre authorizations which delay the treatment process.

Instead, when you go out of network, you and your provider will make a contract between the two of you. An ethical provider will communicate his rates, treatment plan, risks, benefits, etc with you so that there are no surprises during your course of care.

Additionally, it’s worth noting that often times insurances offer out of network coverage that becomes less expensive than going in network. Thereby allowing you to recover most of what you have paid your provider and allowing your provider to give you the highest quality of care.

At Professional Physical Therapy and Training, LLC we pride ourselves on providing the highest level of care as well as being open and honest about our billing practices. If you have any questions, please feel free to call or stop in.